RESUMEN
BACKGROUND: Bloodless pancreatic surgery (BPS) is rarely performed and/or reported. We aim to characterize perioperative and anesthetic strategies in BPS. MATERIALS AND METHODS: A literature search was performed on MEDLINE looking for case reports/case series using search terms ("Jehovah's Witness" [All Fields]) AND ("Pancreatic Surgery" [All Fields] OR "Pancreaticoduodenectomy" [All Fields] OR "Distal Pancreatectomy" [All Fields]). Data regarding categorical variables are reported as proportions and quantitative continuous variables as medians with ranges or means with standard deviation. Forty-one patients requiring BPS are reported in the literature with three additional cases from our institution (n = 44). The data analyzed included clinicopathologic factors, BPS strategies, patient complications, and in-hospital mortality. RESULTS: The most common procedure and diagnosis were pancreaticoduodenectomy (n = 34, 77.3%) and pancreatic ductal adenocarcinoma (n = 12, 27.3%), respectively. Transfusion reduction strategies in BPS fell into three categories: preoperative, intraoperative, and postoperative. Preoperative strategies included iron supplementation (n = 24, 54.5%) and erythropoietin administration (n = 14, 41.2%). Intraoperative strategies included acute normovolemic hemodilution (n = 30, 68%) and cell saver (n = 4, 9.1%). Postoperative strategies included erythropoietin (n = 16, 48.5%) and iron supplementation (n = 16, 48.5%). Complications occurred in 21 (60%) patients. There was no in-hospital mortality among the 44 patients in this cohort. CONCLUSIONS: A broad spectrum of bloodless medicine and surgery practices were used based on patient selection, multidisciplinary practice, and preference. With careful perioperative and anesthetic management, BPS can be performed with good outcomes.
Asunto(s)
Transfusión Sanguínea/ética , Procedimientos Médicos y Quirúrgicos sin Sangre/métodos , Comunicación Interdisciplinaria , Pancreatectomía/métodos , Complicaciones Posoperatorias/epidemiología , Anciano de 80 o más Años , Transfusión Sanguínea/estadística & datos numéricos , Procedimientos Médicos y Quirúrgicos sin Sangre/efectos adversos , Procedimientos Médicos y Quirúrgicos sin Sangre/ética , Carcinoma Ductal Pancreático/cirugía , Estudios de Factibilidad , Femenino , Mortalidad Hospitalaria , Humanos , Testigos de Jehová , Masculino , Persona de Mediana Edad , Pancreatectomía/efectos adversos , Pancreatectomía/ética , Neoplasias Pancreáticas/cirugía , Prioridad del Paciente , Selección de Paciente , Atención Perioperativa/ética , Atención Perioperativa/métodos , Atención Perioperativa/estadística & datos numéricos , Complicaciones Posoperatorias/etiologíaRESUMEN
The management of patients suffering from chronic incurable organic disease combined with a strong element of psychiatric disorder requires patience. Sometimes the involved physicians reach their limits and are pushed to the brink of resignation.